Incidence and Clinico-Pathological Features of Triple Negative Receptors Status in Carcinoma Breast in Our Institution

INTRODUCTION: Breast cancer is the most common cancer among females in urban India and is rapidly catching up with cervical cancer in rural India. An estimated about 1 Million cases of breast carcinoma has been diagnosed annually worldwide. Of these, more than 170,000cases are diagnosed as Triple-Negative. Triple-Negative Breast Cancer (TNBC) is defined by the lack of protein expression of estrogen receptor (ER) and progesterone receptor (PR) and the absence of HER2 protein over expression. Triple-negative breast cancer (TNBC) accounts for approximately 15% of breast cancers. • TNBC is a Very aggressive tumour, poor prognostic factor for disease-free and overall survival, • No effective specific targeted therapy is available for TNBC, • There is a clustering of TNBC cases in premenopausal women. The prevalence of TNBC is highest in premenopausal African American women; a recent report notes that 39% of all African American Premenopausal women diagnosed with breast cancer are diagnosed with TNBC. Currently, effective treatment options are limited to chemotherapy, but the majority of patients who fail to achieve pathologic complete response after chemotherapy has unfavorable prognosis. AIM OF THE STUDY: Carcinoma breast is one of the most common cancer diagnosed and one of the most common cause of cancer related mortality. The aim of the study is to determine Incidence of Triple Negative Breast Cancer (TNBC) in Stanley, To analyze the ClinicoPathological features of Triple Negative breast cancer and to compare it with reports from other regions of the world. MATERIALS AND METHODOLOGY: The material for our prospective study was conducted in Department Of General Surgery And Dept Of Medical Oncology in GOVERNMENT STANLEY MEDICAL COLLEGE AND HOSPITAL, CHENNAI 1, From October 2015 to September 2016 (12 months duration). ALL NEW CASES OF CARCINOMA BREAST Patients who attended Stanley Medical College for treatment were subjected to Trucut Biopsy. For all patients, the pathology was reviewed to confirm the diagnosis and the hormonal receptor and Her-2-neu status. We analyzed the clinicopathologic features of all triple negative cases which were diagnosed in this period. The TNM staging was based on clinical and radiological findings, Later all cases has been followed up for treatment details. DISCUSSION: Incidence was very high (28%) in our study when compared to all others, mean age was 48.6yrs which is slightly lower when compared to Study done in mayo clinic (59.7yrs) Singapore (53yrs) Egyptian (52yrs). Premenopausal Status was lower (57.4%) when compared to Mulago (74%), Turkey (70%0), Bauer et al (64.6%) and it was slightly higher when compared to North India (52%) and Egyptians (48%). Parity more than 3 was lower (57.4%) when compared with North India study (71%). IDC is more common in our Study group (94%) along with Japan (95%), Singapore (93%) and Egyptian (93%). Grade 3 was more in all study groups highest in Japan (92%). Lymphovascular Invasion is also common (58%) in our study highest seen in North India (70%). Stage II with T2 lesion is more common in our Study (47%) which was lower when compared to other studies. Nodal spread (83%) and Metastasis (23%) is more common in our study when compared to other studies. CONCLUSION: Incidence rate of Triple Negative Breast Cancer (TNBC) is higher in our study, Affecting younger females with no significant risk factors or family history, Associated with significant poor prognostic factors like Nodal spread positivity, High grade tumor, Intra Ductal Carcinoma type, Lymphovascular invasion and metastasis. Therefore this study Shows TNBC is Very Aggressive tumor with increasing incidence rate among South Indian Population and this finding throws more light on the need for treatment strategies to be better tailored to effectively treat the TNBC patients

Does a routine post brush bronchial wash increase the yield in diagnosis of lung cancer?

Background: Lung cancer is the most common cause of cancer-related death in both men and women. 80% of the lung cancers are non-small cell lung cancer (NSCLC) and 20% are small cell lung cancer (SCLC). Flexible fiberoptic bronchoscopy is commonly used for diagnostic and staging purposes. Endoscopically visible abnormalities are approached with traditional biopsy forceps, brushings, and washings. Objectives were to assess the yield of bronchial washings, brush cytology and to compare the yield of pre and post brush bronchial washings.Methods: Patients with suspicion of lung cancer will be subjected to bronchoscopy using flexible fibreoptic bronchoscopy. Multiple procedures performed for the retrieval of tissue samples will include bronchial washings (pre and post brushing), bronchial brushing and endobronchial biopsy.Results: A total of 57 cases were included in the study with 40 (70.2%) males and 17 females (29.8%). The yield of pre-brush bronchial washings, post brush bronchial washings and bronchial brushings were 31.6% (18 of 57), 31.6% (18 of 57) and 61.4% (35 of 57) respectively. Biopsy was positive for malignancy in 11 of 19 (58.2%) cases. Adenocarcinoma was the commonest type seen in 32 (56.1%) patients. Of the 27 cases with endobronchial growth 11 were adenocarcinoma (40.7%).Conclusions: There was no difference between the yield of pre-brush washing and post brush washing. The yield of brush cytology was significantly more than the yield of bronchial washings. There is an increase in the yield after adding both pre and post brush bronchial wash.

Epidemiological and laboratory investigations of outbreaks of diarrhoea in rural South India: implications for control of disease

Two epidemics of acute, watery diarrhoea in villages in North Arcot district, India, were investigated. The attack rates were 10.03 and 15.53 per 100 population, the median duration was 5 days and enteric pathogens were present in 56.8% and 60.3% of specimens from the two villages, but no predominant pathogen was identified. Examination of stools from a 20% age-stratified random sample of the population of one of the villages after the epidemic found 22.9% of asymptomatic subjects excreted bacterial enteric pathogens. Despite the high background of enteric pathogen carriage, the isolation rates for shigellae, enteropathogenic Escherichia coli and Shiga-toxin producing E. coli were significantly higher (P < 0.001, P < 0.02, P < 0.05) during the epidemic. The epidemics may have been caused by faecal contamination of well water following rain. Point-of-use techniques for water disinfection may be most effective for preventing such outbreaks, but further research into the development of appropriate technology is required

Evaluating and improving adaptive educational systems with learning curves

Personalised environments such as adaptive educational systems can be evaluated and compared using performance curves. Such summative studies are useful for determining whether or not new modifications enhance or degrade performance. Performance curves also have the potential to be utilised in formative studies that can shape adaptive model design at a much finer level of granularity. We describe the use of learning curves for evaluating personalised educational systems and outline some of the potential pitfalls and how they may be overcome. We then describe three studies in which we demonstrate how learning curves can be used to drive changes in the user model. First, we show how using learning curves for subsets of the domain model can yield insight into the appropriateness of the model’s structure. In the second study we use this method to experiment with model granularity. Finally, we use learning curves to analyse a large volume of user data to explore the feasibility of using them as a reliable method for fine-tuning a system’s model. The results of these experiments demonstrate the successful use of performance curves in formative studies of adaptive educational systems

Trial-by-Trial Variations in Subjective Attentional State are Reflected in Ongoing Prestimulus EEG Alpha Oscillations

Parieto-occipital electroencephalogram (EEG) alpha power and subjective reports of attentional state are both associated with visual attention and awareness, but little is currently known about the relationship between these two measures. Here, we bring together these two literatures to explore the relationship between alpha activity and participants’ introspective judgments of attentional state as each varied from trial-to-trial during performance of a visual detection task. We collected participants’ subjective ratings of perceptual decision confidence and attentional state on continuous scales on each trial of a rapid serial visual presentation detection task while recording EEG. We found that confidence and attentional state ratings were largely uncorrelated with each other, but both were strongly associated with task performance and post-stimulus decision-related EEG activity. Crucially, attentional state ratings were also negatively associated with prestimulus EEG alpha power. Attesting to the robustness of this association, we were able to classify attentional state ratings via prestimulus alpha power on a single-trial basis. Moreover, when we repeated these analyses after smoothing the time series of attentional state ratings and alpha power with increasingly large sliding windows, both the correlations and classification performance improved considerably, with the peaks occurring at a sliding window size of approximately 7 min worth of trials. Our results therefore suggest that slow fluctuations in attentional state in the order of minutes are reflected in spontaneous alpha power. Since these subjective attentional state ratings were associated with objective measures of both behavior and neural activity, we suggest that they provide a simple and effective estimate of task engagement that could prove useful in operational settings that require human operators to maintain a sustained focus of visual attention

Performance Analysis of Montgomery Multiplier using 32nm CNTFET Technology

In VLSI design vacillating the parameters results in variation of critical factors like area, power and delay. The dominant sources of power dissipation in digital systems are the digital multipliers. A digital multiplier plays a major role in a mixture of arithmetic operations in digital signal processing applications hinge on add and shift algorithms. In order to accomplish high execution speed, parallel array multipliers are comprehensively put into application. The crucial drawback of these multipliers is that it exhausts more power than any other multiplier architectures. Montgomery Multiplication is the popularly used algorithm as it is the most efficient technique to perform arithmetic based calculations. A high-speed multiplier is greatly coveted for its extraordinary leverage. The primary blocks of a multiplier are basically comprised of adders. Thus, in order to attain a significant reduction in power consumption at the chip level the power utilization in adders can be decreased. To obtain desired results in performance parameters of the multiplier an efficient and dynamic adder is proposed and incorporated in the Montgomery multiplier. The Carbon Nanotube field effect transistor (CNTFET) is a promising new device that may supersede some of the fundamental limitations of a silicon based MOSFET. The architecture has been designed in 130nm and 32nm CMOS and CNTFET technology in Synopsys HSpice. The analysed parameters that are considered in determining the performance are power delay product, power and delay and comparison is made with both the technologies.The simulation results of this paper affirmed the CNTFET based Montgomery multiplier improved power consumption by 76.47% ,speed by 72.67% and overall energy by 67.76% as compared to MOSFET-based Montgomery multiplier

The repeatability and reproducibility of four techniques for measuring horizontal heterophoria: Implications for clinical practice

PURPOSE: Convergence insufficiency, the most common binocular vision anomaly, is characterised by a receded near point of convergence and an exophoria which is at least 4 prism dioptres (Δ) larger at near than at distance. However, the repeatability of standard heterophoria measures are poorly understood. This study assessed the ability of four common heterophoria tests to detect differences of 4Δ by evaluating the inter- and intra-examiner variability of the selected techniques. METHODS: Distance and near horizontal heterophorias of 20 visually-normal adults were measured with the alternating prism cover test, von Graefe prism dissociation, Howell Card and Maddox Rod by two examiners at two separate visits using standardised instructions and techniques. We investigated inter- and intra-examiner variability using repeatability and reproducibility indices, as well as Bland-Altman analysis with acceptable limits of agreement defined as ±2Δ. RESULTS: The Howell card test had the lowest intra-examiner variability at both distance and near, as well as the best 95% limits of agreement (±1.6Δ for distance and ±3.7Δ for near). Inter-examiner reproducibility results were similar, although at near the alternating prism cover test had better repeatability (1.1Δ, 95% confidence intervals −1.1Δ to 4.0Δ) than the Howell card (1.4Δ, 95% confidence intervals −1.9Δ to 5.9Δ). CONCLUSION: The low repeatability of many standard clinical heterophoria tests limits the ability to reliably detect a 4Δ difference. The Howell Card provided the most repeatable and reproducible results indicating that this technique should be used to detect small changes in heterophoria magnitude and direction

The effects of changes in glutathione levels through exogenous agents on intracellular cysteine content and protein adduct formation in chronic alcohol-treated VL17A cells

Alcohol-mediated liver injury is associated with changes in the level of the major cellular antioxidant glutathione (GSH). It is interesting to investigate if the changes in intracellular GSH level through exogenous agents affect the intracellular cysteine content and the protein adduct formation indicative of oxidative insult in chronic alcohol treated liver cells. In VL-17A cells treated with 2mM N-acetyl cysteine (NAC) or 0.1mM ursodeoxycholic acid (UDCA) plus 100mM ethanol, an increase in cysteine concentration which was accompanied by decreases in hydroxynonenal (HNE) and glutathionylated protein adducts were observed. Pretreatment of 100mM ethanol treated VL-17A cells with 0.4mM buthionine sulfoximine (BSO) or 1mM diethyl maleate (DEM) had opposite effects. Thus, altered GSH level through exogenous agents may either potentiate or ameliorate chronic alcohol-mediated protein adduct formation and change the cysteine level in chronic alcohol treated VL-17A cells. The gene expression of non-treated and ethanol-treated hepatocytes in 2 microarray datasets was also compared to locate differentially expressed genes involved in cysteine metabolism. The study demonstrates that increased protein adducts formation and changes in cysteine concentration occur under chronic alcohol condition in liver cells which may increase alcohol-mediated oxidative injury